You are not connected. The newsletter may include some user information, so they may not be displayed correctly.

Notes on POLST April 2020

April 2020

COVID-19

The professional and personal impact of COVID-19 on Pennsylvanians is extraordinary. Health care professionals (HCP) have responded with a deep commitment and resilience. Institutions have responded with useful education on how to avoid COVID-19 while providing services in acute and long-term care and in other facilities in the community. We are providing a list of website resources, some of which may be useful to you.

‍The Pennsylvania Department of Health and the Hospital and Healthsystem Association of Pennsylvania have developed Interim Pennsylvania Crisis Standards of Care for Pandemic Guidelines. “The purpose of this document is to guide the allocation of patient care resources during an overwhelming public health emergency of any kind when demand for services dramatically exceeds the supply of the resources needed “.

‍National POLST. To help address questions about POLST during the coronavirus pandemic, the national office has provided material for health care professionals and facilities.

Guidance for Completing POLST Forms in Crisis Standards of Care

COVID-19 Statement

Long Term Care Facility Guidance

‍Center to Advance Palliative Care (CAPC) has made its toolkit resources and online courses publicly available. Most of the information is applicable to all types of medical practice. Some of the topics are:

- Using Telehealth

- Public and Family Support

- Health Care Setting Specific Guidance.

- Communication Tips

https://www.capc.org/toolkits/covid-19-response-resources/

‍VitalTalk, COVID-Ready Communication Skills. This open source primer that gives practical advice on how to talk about difficult topics related to COVID-19, including specific phrasing for patient and family conversations.

https://vitaltalk.org/guides/covid-19-communication-skills

‍Centers for Disease Control and Prevention (CDC). This comprehensive site offers the latest update on the number of cases within the country. Further it includes specific information for the public, resources for the community and detailed information for HCP and facilities.

https://cdc.gov/coronavirus/2019-ncov/index.html

‍AMDA. This is a resource recommended for administration and staff of Pennsylvania long-term care facilities. Found at the side are daily updates, guidance, recommendations and tools along with pertinent podcasts and webcasts.

https://paltc.org/COVID-19

The Communication Challenge

During this time that presents extraordinary challenges to health care professionals, patients and families, it is expected that more goals of care conversations are occurring within a difficult situation.

‍The OHSU Center for Ethics in Health Care is providing access to conversation teaching tools that were produced specifically in context of the COVID-19 pandemic. We are pleased to share the following four videos.

‍

Communicating in a Crisis: Skills to Honor Previously Determined Preference for Medical Care. Reveals how follow up goals of care conversations may differ based on a patient’s recollection of previous end of life choices and advancing illness. It provides specific guidance on how to have successive conversations.

‍

POLST and Coronavirus: If you get sick, do your orders match your wishes? Intended for patients and families of those who already have a POLST because of frailty or serious illness and are thus among the mostly likely not to survive if they get the coronavirus. It can help those with a preexisting POLST understand what their orders mean and encourages them to talk to their families. The goal is support patients’ ability to plan ahead if they get sick and to be able to avoid hospitalization if that is their wish.

‍

POLST Conversation for ED Physicians with a Capable Patient.

‍

POLST Conversation for ED Physicians with a Surrogate.

‍POLST DO's and Don'ts

‍The following is intended to help reinforce important facts, make users aware of common misconceptions and avoid errors associated with the POLST process. It was prepared by Leon Kraybill MD, CMD, Lancaster General Health/Penn Medicine.

‍It is NOT appropriate to :

‍Require any individual to complete a POLST

‍Establish a facility policy to require POLST completion for all residents

‍Incentivize medical providers based

on POLST completion or counting

‍Confuse “cardiac arrest” with “respiratory arrest” in a patient with “DNR but FULL medical intervention”

‍Assume that a “DNR, comfort measures only” choice always means no hospitalization

‍Include the POLST form in the LTC admission packet (conveys that it is just a paper completion formality).

‍Discuss and complete a POLST document only with the HCPOA/representative of an

individual who has full decision-making capacity

‍Discuss and complete a POLST document only with an individual with limited or no decision-making capacity

‍Assume that an individual with advanced or irreversible or terminal illness will choose a “DNR” status

‍Assume that POLST choices will stay the same

‍It is appropriate to:

‍Okay to suggest and assist

‍Okay to offer to all appropriate residents

‍Okay to incentivize advance care planning discussions and documentation

‍Ventilation support may still be desired by the individual who is not in full cardiac arrest

‍Interventions for comfort are still appropriate. Examples: injuries like hip fracture, or lacerations

‍Okay to provide introductions to the topic and subsequent conversations – brochures, videos like “POLST: When is the right time” or “Understanding POLST”

‍The HCPOA/representative may be included, with the permission of the resident.

‍Discuss if possible with the resident but confirm choices with HCPOA/representative

‍Okay to inquire about their understanding of their illnesses, the ability to improve, and the likely benefit of medical intervention

‍POLST is a guide based on decisions at a particular point. When time and medical circumstances allow, it should always be confirmed during subsequent medical changes

Taking Care of Yourself While Taking Care of Others

We are closing with information that may useful for sharing with patients or residents and may be helpful personally if you have family concerns. The website of the National Council of Aging is intended to be a resource for older adults and caregivers to assist them in meeting urgent needs. There is information on staying healthy and connected while being confined, in addition to links for additional support during the COVID-19 pandemic.

https://www.ncoa.org/covid-19/covid-19-resources-for-older-adults/

Finally to all our dedicated professional caregivers, please take good care of yourself physically and emotionally. As health care workers labor to contain this crisis and provide care to patients, self-care is critical. This video can help individuals cope with their own feelings and deal with fears, guilt, anger, and other emotions, ‘Caring for Yourself and Caring for Others During a Disaster/Epidemic”.